Improving Provider Data Accuracy with Blockchain

Session 126, February 13, 2019

Jason O’Meara, Senior Director Enterprise Management and Architecture, Quest Diagnostics

Kyle Culver, Principal Blockchain Architect, Humana

Mike Jacobs, Senior Distinguished Engineer, Optum

• Dan D’Orazio, Chief Executive Officer, Sage Growth Partners

• Jason O’Meara, Senior Director Enterprise Management and

Architecture, Quest Diagnostics

• Kyle Culver, Principal Blockchain Architect, Humana

• Mike Jacobs, Senior Distinguished Engineer, Optum

Has no real or apparent conflicts of interest to report.

Conflict of Interest

WELCOME

1. Define the current state of provider data exchange.

2. Evaluate the use of blockchain technology to address

healthcare challenges.

3. Demonstrate how healthcare organizations can work

together to leverage blockchain technology to provide

more effective patient care.

Today’s learning objectives

Jason O’Meara

Senior Director Enterprise

Management and Architecture

Quest Diagnostics

Kyle Culver

Principal Blockchain

Architect

Humana

Mike Jacobs

Senior Distinguished

Engineer

Optum

Provider data management

Maintaining Accurate Demographics Within a

Provider Directory is a Required Capability for Health Plans

Provider directory information changes often, and is used by

members and sales reps frequently

Over 18 months, half of directory

entries have a change*

One of a health plan member’s most

common interactions with their plan is

searching its provider directory

Name

Address

Phone Number

Specialty

Accepting New Patients Indicator

Example Demographic Elements

*Enclarity. (2014). A business case for fixing provider data issues. Retrieved February 26, 2018, from lexisnexis.com

Provider data challenges

Name Address Phone Accepting

Patients

Other

Data

2.1

Billion/Year

Payers

Collectively

Spend Improving

Provider Data*

• Patients seek care from out-of-network providers

• Providers endure unnecessary billing and administrative complications

• Health information exchanges (HIEs) and organizations cannot effectively

enable the secure sharing of patient information

• Health plans have higher than necessary administrative burden and costs,

impact consumer costs and risk violating state and federal requirements

Impact of Incomplete, Poor Quality Data

*“Streamlining Provider Data Management Could Save Billions…but Is It Possible?”, Health Plan Week, Vol 27, No. 4 (January 2017).

Synaptic Health Alliance

Aetna, Ascension, Humana,

Multiplan, Optum, Quest

Diagnostics and

UnitedHealthcare have

formed the Alliance to explore

how blockchain technology

could help address some of

the toughest problems in

healthcare

What we learned about an alliance

Transparency and open dialogue is critical the success of the

alliance.

Mutual respect on hot-button topics is necessary: brand,

finances, intellectual property, data access and resources.

Governance provides the framework for ongoing collaboration

and decision-making.

Alliance complexity reduces velocity: multi-party decisions,

resource variability, compared to a single organization with a

single agenda.

Efficiencies when working together to tackle an industry

problem vs. working in our own siloes.

Business value assessment approach

• Overlap analysis to select single market: Texas

• Single market to minimize impact on operational

resources

• Point-in-time snapshot of data

• Independent theories of where to discover value

• Traditional outbound call campaigns to test

theories

• Small sample sizes (e.g. 1,900 records per org.)

provided directional guidance

• Decoupled business value assessment from

technology development to move faster

What we learned with the technology

We evolved with the technology. Initial experiences with

several blockchain technologies led us to select Quorum.

How to optimize smart contract data structures. Novel

contracts that can work with data between all

organizations.

How to deploy for enterprise-class needs. A truly

decentralized multi-cloud, multi-enterprise blockchain

network was proven out.

Synaptic network

Node

NodeNode

Node

Smart Contracts

Quorum

Blockchain

All nodes are the

same but owned by

different alliance

members

Overall finding and relevance

Findings provide directional guidance toward coordinating

provider directory work across alliance members.

CMS considers inactive locations listed in a provider

directory to be a deficiency of the highest weight.*

The most immediate benefits were found to be the

identification of inactive locations and mismatched

addresses.

*CMS, Online Provider Directory Review Report 2018

Representative Findings: Inactive Locations

Percent of the

time a member’s

active provider

record should be

changed to

inactive based

on shared data.

Potential percentage

with the correlation

of additional

business data.

67-88% 88+%

+ Claim Data

+ Attestation

4-5x

Anticipated increase in the outreach call effectiveness

when removing inactive locations compared against

typical phone outreach.

Representative Findings: Address Mis-

matches

80-89% 89+%

Percent of the

time an address

for a member’s

active provider

record should be

changed based

on shared data.

Potential

percentage with

the correlation of

additional

business data.

+ Claim Data

+ Attestation

Some members found the potential for write-off recovery opportunities

that could put real dollars back into the business.

Questions?

Answers.